POPULATION HEALTH PROMOTION APPROACH

Transcription

1 February 2006 Towards a POPULATION HEALTH PROMOTION APPROACH A Framework and Recommendations for Action

2 EXECUTIVE SUMMARY Population health is an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups. In order to reach these objectives, it looks at and acts upon the broad range of factors and conditions that have a strong influence on our health (from the Public Health Agency of Canada). A population health approach has the potential to not only improve health status, but to contribute to the overall sustainability of the health care system. This method requires action in four areas: LEADERSHIP > This involves recognizing the existence of a health issue or health disparity and assuming a responsibility to redress it. PARTNERSHIPS > Responding to health issues often requires action across more than one jurisdiction, requiring inter-sectoral strategies. Partnerships are essential components of a population health strategy and facilitate the creation of health promoting environments and conditions for the population. ADVOCACY > Advocacy is an effective strategy for addressing the social determinants of health. This strategy often calls for a visible leader or spokesperson that can raise awareness and represent the need to the public, media and political bodies. POLICY DEVELOPMENT > Healthy public policy is a critical component in the move to shift health care from an illness driven model to one that focuses on the health status of the population. Policy development can be a key outcome of advocacy and lobbying efforts and can be addressed at a number of levels. A series of recommendations have been developed to implement a population health promotion strategy in Vancouver Coastal Health. These include population health promotion workshops for members of leadership groups; the creation of a population health promotion leadership position; the creation of a population health surveillance unit; an annual VCH Population Health Report; a Population Health Promotion Collaborative; and, support for community based health promotion initiatives. 2

3 BACKGROUND Vancouver Coastal Health (VCH) delivers an array of programs through three service networks acute care, community care and primary health care. Although these services have an impact on the health of the VCH population, significant improvements can also be made through illness avoidance strategies and the creation of programming/policies directed at vulnerable population groups. The cost of providing health care services is staggering and will continue to escalate with the advent of newer, complex and expensive technologies and pharmaceuticals. Sustainability is a key issue for the health system. Through an investment in population health promotion, and a corresponding reduction in the burden of illness, VCH can strategically contribute to a more sustainable health care system. Each avoided illness can potentially translate into avoided diagnostic and treatment services. In addition to the impact on people s health and the direct costs of the health care system, population health and public health strategies produce a significant return on investment from a broader economic point of view. Interventions to prevent disease and disability can have a significant impact on future healthcare costs. As seen in the chart below, the costs for providing Diabetes care can be reduced through the promotion of healthy lifestyles (i.e. healthy weights). Estimated Actual and Projected Health Service Costs for Persons with Diabetes, Under Varying Assumptions as Population Control of Overweight in 10 Years, B.C. 1993/94 to 2011/12 Costs (millions) $1,200 $1,000 $800 $600 Constant 1999 $ Current Year $ Prevalence of Overweight 45% 30% 15% $400 $200 $0 1993/ / / / / / / / / / / / / / / / / / /12 0% Year 1 The term population health promotion is used in this paper to encompass a broad range of interventions. These include population health strategies that focus on multi-sectoral actions to address the determinants of health, as well as more targeted health service interventions such as health promotion aimed at building community capacity reducing health risks in specific populations or changing individual health behaviors. 3

4 DEFINITION Population health is an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups. In order to reach these objectives, it looks at and acts upon the broad range of factors and conditions that have a strong influence on our health (from the Public Health Agency of Canada). As an approach, population health focuses on the interrelated conditions and factors that influence the health of populations over the life course, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to develop and implement policies and actions to improve the health and well-being of those populations. (Federal/Provincial/Territorial Advisory Committee on Population Health) This definition makes it clear that to influence the health outcomes of a population, it is essential to have an understanding of the interrelated conditions and factors that influence health the determinants of health. Some examples of the determinants of health include education, employment, income, housing, adequate nutrition, social supports, social networks, and access to health care services. In addition to identifying these determinants, it is also necessary to have the will to develop and implement policies and actions that will lead to improved health and, most importantly, eradicate the disparities in health across population groups. The Vancouver Coastal Health Vision statement commits to supporting healthy lives in healthy communities with our partners through care, education, and research. VCH currently approaches this commitment primarily through an individual patient/client based perspective. In contrast, a population health approach focuses on the health influencing factors that exist outside of individuals. These may occur both within and between groups of individuals, including families, neighborhoods, communities or geographic regions. Population health is not synonymous with targeted health interventions aimed at specific sub-populations, such as a prevention program for people with mental illness. Population health is about systems changes (i.e., education system, housing, recreation system) in the context of the population and the communities where people live. Population health is also not synonymous with public health, although there are many population health strategies that are advanced through public health actions. Consequently, the public and community health programs being offered by VCH, while valuable, are not solely able to address the broad scope of health determinants identified above. It is important to understand that a commitment to improve population health does not always demand a service or program type response to the need. However, it does demand that VCH recognize when and where there exists a need to improve health status or reduce inequities. This recognition should result in action to bring awareness, understanding and ultimately a resolution to the issue. 4

5 KEY POPULATION HEALTH PROMOTION ELEMENTS Canada is considered a worldwide leader in population health. The model of population health promotion shown in the following figure was developed to show the inter-related components that make up a population health promotion approach. As shown in this model, these include: Re-orienting health services Developing personal skills Creating supportive environments Building healthy public policy Strengthening community action Income & Social Status Social Support Networks Education Working Conditions Physical Environments Biology & Genetics Personal Health Practices & Coping Skills Health Child Development Health Services EVIDENCE-BASED VALUES & SOCIETY SECTOR/SYSTEM Research Evaluation COMMUNITY FAMILY INDIVIDUAL Strengthen Community Action Build Healthy Public Policy Create Supportive Environments Develop Personal Skills Reorient Health Services DECISION MAKING Experiential Learning ASSUMPTIONS This is a powerful framework that provides a foundation for the design of a population health promotion approach. Implementation of the framework is dependent on some key strategies that must be a cornerstone of a population health approach within VCH. As one of the largest health authorities in Canada, VCH has the potential to be a national leader in population health. Population health based actions require: leadership, partnership, advocacy, and policy development all factors that influence the inter-relationships between individuals within populations. 5

6 LEADERSHIP > This involves recognizing the existence of a health issue or health disparity and assuming a responsibility to redress it. Actions may include developing alliances, coalitions or partnerships, particularly for issues that are cross-jurisdictional such as those involving local governments or politicians. For example, this strategy has been successful in addressing housing issues and issues of harm reduction through the vibrant Four Pillars approach in Vancouver s Downtown eastside. The success of this approach was dependent on the proactive leadership shown the by the mayors of Vancouver, leaders in the Vancouver/ Richmond Health Board and members of the Vancouver Police Department. VCH is currently working with the Healthy Living Alliance, the BC Recreation Council and municipal parks and recreation departments to champion healthy active living initiatives. Political leadership is often critical to the success of these approaches. A central facet of this strategy is the development of leaders and champions within communities. If leadership from within the health sector is not practical, possible, or desirable, then the Health Authority can work to cultivate a champion and leader from within another sector of the community. PARTNERSHIPS > Partnerships are essential components of a population health strategy that facilitate the creation of health promoting environments and conditions for the population. Responding to health issues often requires action across more than one jurisdiction, requiring inter-sectoral strategies. A Health Authority can also play the role of an instigator of a partnership if it recognizes a health issue where the resolution rests outside its formal jurisdiction. Across VCH, there are numerous examples of partnerships ranging from the Vancouver Agreement to Richmond s substance abuse strategy to the North Shore s homelessness strategy. 6

7 ADVOCACY > Advocacy is an effective strategy for addressing the social determinants of health. This strategy often calls for a visible leader or spokesperson that can raise awareness and represent the need to the public, media and political bodies. Social, political and Through advocacy,the primary health care principles of equity and accessibility are taken into account and actively promoted in the development of needed resources for the disadvantaged. economic factors are all potential areas of advocacy for political action and policy change. Advocacy can be one of the most effective population health/ health promotion strategies, with the end result being the development and implementation of policy that directly impacts health outcomes on a sustained basis. POLICY DEVELOPMENT > Healthy public policy is a critical component in the move to shift health care from an illness driven model to one that focuses on the health status of the population. Policy development can be a key outcome of advocacy and lobbying efforts and can be addressed at a number of levels. At both micro and macro levels, healthy public policy should focus on population health with an emphasis on health status, equity, and multi-disciplinary and The policies of the VCH multi-sectoral elements consistent with the principles of Primary Health Care Network are an primary health care. example of internal policy development that can influence the health of the population. Through these policies, the Network is undertaking the development of an infrastructure that will support individuals in These approaches are relevant to all levels and assuming more responsibility for their members of the Health Authority. It is only through the own medical conditions recognition and acceptance of responsibility for the health and care. status of our community and population that any meaningful progress will be made. The path to be avoided is to assume it is someone else s job or domain and they will look after it. Equally undesirable is to maintain that it is everyone s job, making responsibility so diluted as to lack focus, and to fail to assign accountability for an outcome. 7

8 V CH POPULATION HEALTH PROMOTION STRATEGIES Vancouver Coastal Health has grouped its services into three interconnected networks acute care, community care and primary health care. VCH is currently developing a population segmentation strategy to complement its three service delivery networks. The goal of this strategy is to identify key target populations that have similar needs and where system-wide strategies and population health approaches may be particularly beneficial. Once defined, VCH wants to ensure that there are formal processes for the defined populations to have involvement in the networks, thus allowing consumer/community needs to help shape the priorities and framework for service delivery. The population groups identified can also be used as the foundation for the strategies outlined in the VCH Population Health Framework. By building on the creation of a population focus within the service delivery networks, VCH can create a resource for community partnerships that can address the broad determinants of health that are beyond the sole ability of the Health Authority to address. An initial set of recommendations have been developed to implement VCH s Population Health Promotion Strategy. These include: 1POPULATION HEALTH PROMOTION WORKSHOPS FOR LEADERSHIP GROUPS In order to increase the understanding and capacity of key VCH leadership groups (i.e., VCH Board and Senior Executive Team) around population health priorities and strategies, workshops can be developed as part of regular planning activities. The workshops are an interactive opportunity for the VCH leadership to familiarize themselves with, and discuss, the important and complex set of strategies that form a population health promotion approach. The workshop is not designed as a didactic exposé of current VCH population health promotion initiatives. Rather it is an opportunity to understand and explore the critical role of senior leadership in population health and the importance of strategies such as policy development, advocacy and political partnerships in improving people s health. 8

9 2LEADERSHIP POSITION POPULATION HEALTH PROMOTION A new leadership position has been created for population health promotion. Currently the responsibility and accountability for population health is diffused throughout VCH at the level of program directors within HSDA s, medical health officers and the Primary Health Care Network. While this diffusion has very real advantages and need not be eliminated, it is important to have a leadership focus to accomplish several outcomes. Responsibilities for this position will include: taking leadership of a Population Health Promotion Collaborative; coordinating internal efforts; facilitating provincial and national collaboration, and initiating advocacy efforts around population health issues. 3POPULATION HEALTH SURVEILLANCE UNIT Central to population health is the ability to analyze the population s health status, burden of disease and emerging health issues through surveillance and intelligence gathering. These capabilities guide the development of appropriate and timely interventions, as well as providing measurements on the impact of population health strategies. With the increasing sophistication and availability of data sets both nationally and provincially, there is a wealth of information that is not being fully utilized to facilitate evidence-based decision-making in population health. A dedicated unit modeled on that currently operating in VIHA, would enhance the analysis of existing databases, as well as ensuring that appropriate surveillance and intelligence gathering was occurring across VCH. The unit would also support the work of the Collaborative (see below) and the development of an annual report on the population health status of VCH. VCH is working with the Provincial Health Services Authority to develop the capacity required to support population health surveillance. 4ISSUE AN ANNUAL VCH POPULATION HEALTH REPORT The nature of many population health issues do not lend themselves to discrete, easily identifiable or measurable indicators. Often, population health initiatives require long-term monitoring before outcomes of success are observable. Further, population health measures demand a narrative or descriptive method supported wherever possible by both intermediate and long-term indicators. An annual report under the auspices of the Medical Health Officer, and patterned after the Provincial Health Officer s report, will summarize the population health of VCH and will assist in identifying areas for strategic policy and partnership development. It will also establish important annual benchmarks for the accountability and performance assessment of VCH in improving the health status of the region s population. 9

10 5A POPULATION HEALTH PROMOTION COLLABORATIVE 6 The formation of a Population Health Promotion Collaborative will not only signal the strategic importance of population health initiatives, but will also provide leadership for a forum where participants from across VCH can come together to identify issues, define measurable outcomes and select actions. The Collaborative, modeled after similar VCH initiatives, would require the same support that has been intrinsic to their success including mentoring and coaching, IT systems support, communication support and other resources as required. SUPPORT FOR COMMUNITY BASED/ INITIATED HEALTH PROMOTION PROGRAMS A cardinal tenet of population health promotion programming is that it must reflect the needs of the community and foster various avenues for community participation. In this way, VCH can be responsive to community ideas and reflect diverse values and views on proposed solutions. As one strategy, VCH has at its disposal the community health promotion fund the SMART Fund, which supports community based health promotion initiatives. Funding has been allocated to expand the SMART Fund. Sources of Information Anderson, E. T. (1996). Community as Partner: Theory and Practice in Nursing. Philadelphia: Lippincott. Epp, J. (1986). Achieving Health for All: A Framework for Health Promotion. Ottawa, ON: Minister of Supply and Services. World Health Organization (1986). Ottawa Charter for Health Promotion. Ottawa: World Health Organization, Health and Welfare Canada & Canadian Public Health Association. Available: Public Health Agency of Canada: Population Health Approach. Shah, C. P. (1998). Public Health and Preventive Medicine in Canada, 4th Edition. Toronto: University of Toronto Press. Stewart, M. J. (2000). Community Nursing: Promoting Canadians Health.Toronto, W.B. Saunders Company. 10

11 CONCLUSION Population health promotion has the potential to improve the health of the people we serve and the sustainability of the health care system. It requires leadership, commitment, a clear mandate and resources to sustain a comprehensive range of strategies. It also requires linkages with the community and populations in need. The evidence about the return on investment in this approach suggests that efforts to expand population health promotion will reap benefits into the future. 11

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